Apparatus and methods for Achilles tendon repair

ABSTRACT

Apparatus and methods for Achilles tendon repair are described where an elongate tendon repair assembly may be introduced into a single incision to access the damaged tissue. The assembly may define a channel for receiving a portion of the tendon and which may provide support to the tissue during repair. One or more retractable needles each carrying a length of suture may be deployed within the channel for piercing through the tendon and a cinching member may secure each of the suture lengths for tensioning the suture against the damaged tendon. Once the suture lengths have been deployed, the needles may be retracted and the device removed from the incision.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/597,037 filed Jan. 14, 2015, now U.S. Pat. No. 9,999,422, which is acontinuation of U.S. patent application Ser. No. 13/113,505 filed May23, 2011, now U.S. Pat. No. 8,936,611, which claims the benefit ofpriority to U.S. Provisional Application No. 61/349,025 filed on May 27,2010, each of which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

The present invention relates generally to medical devices and methodsused for attaching soft tissues to one another. More particularly, thepresent invention relates to apparatus and methods for re-attaching adamaged tissue region to one another such as a ruptured Achilles tendonin a minimally invasive manner.

BACKGROUND OF THE INVENTION

Soft tissue damage, particularly tendon rupture such as the Achillestendon, is typically a debilitating event. Surgical repair of a rupturedtendon generally requires the torn or ripped ends of the tendon, whichare separated from one another, to be coapted by passing one or moresutures through each damaged end. Each of the torn ends are drawntowards one another by tightening of the sutures to restore theconnecting muscles and tendon to their original lengths.

However, accessing the damaged tissue generally requires relativelylarge incisions or multiple smaller incisions for effecting adequatepurchase and sufficient suturing of the damaged tendon to ensure properhealing of the tendon. Yet relatively large incisions or multipleincisions also increase the likelihood of infections and complicationsoccurring.

Moreover, minimally invasive devices which may be inserted throughrelatively smaller incisions are generally limited in their applicationfor repairing particular tissue regions. For instance, minimallyinvasive surgical instruments may enable a surgeon to pass suturesthrough tissue with the instruments introduced through relatively smallincisions; however, these instruments are limited in their ability topass multiple sutures through non-supported tissue structures in anefficacious manner.

Moreover, may such devices are insufficient in supporting tissuestructures such as ruptured or torn tendons for minimally invasivesurgical repair. Thus, tissue repair systems which are able to pass oneor more sutures in a minimally invasive manner into tissue structures,such as the Achilles tendons, which are difficult to secure andmanipulate are highly desirable.

BRIEF SUMMARY OF THE INVENTION

In repairing damaged regions of tissue, an elongate assembly may beintroduced into a single incision to access damaged tissue such as aruptured or torn Achilles tendon. Thus, a tendon repair assembly maygenerally comprise an elongate body which allows for insertion of theinstrument through a relatively small incision into proximity of thedamaged tendon. The assembly may comprise a channel for receiving aportion of the tendon and which may provide support to the tissue duringrepair. Although described in reference to the suturing and repair oftendons, particularly the Achilles tendon, the devices and methodsdescribed herein may be utilized on other tissue regions.

An example of a tendon repair assembly may generally comprise a handlehousing having a handle grip and an actuator operable relative to thehousing. An elongate shaft may extend from the housing and terminatewith a distal end which may be rounded or atraumatic to prevent damageto surrounding tissues when the elongate shaft is introduced into thebody of the patient. The length of the elongate shaft may extend toabout 5 cm although the shaft may be lengthened or shortened as desiredor necessary. Moreover, the shaft may have a circular cross-sectionalshape ranging, e.g., between 2 to 2.5 cm in diameter, while in othervariations the cross-sectional shape may be elliptical or another shapeconducive for atraumatic insertion within the patient's body.

The elongate shaft may define a receiving channel which runs along atleast a portion of the length of the shaft and is sized to allow for thedamaged or ruptured tendon to be inserted or enclosed at least partiallyor completely within the channel. The opening of the channel may besized sufficiently to allow for entry of the tendon within and mayaccordingly vary depending upon the application and size of the tendon.Typically, the channel may range anywhere from 45 degrees to 180 degreesrelative to the circumference of the shaft but the opening may be lessor greater depending on the application. Moreover, the channel may bedefined along the shaft at an angle relative to an orientation of thehandle. In one example, the grip of handle may be angled anywhere fromabout 45 degrees or greater, e.g., 90 degrees, about the longitudinalaxis of the shaft relative to the opening of the channel. Having anangled orientation between the handle and the channel may allow for theinsertion of the shaft into the posterior region of the patient's leg toaccess the Achilles tendon without any interference between the handleand the patient's foot or leg.

One or more needles which are retractably or pivotably extendable from alow profile configuration within the channel may be positioned within oralong the walls of shaft such that when retracted, the needles may beflush or hidden within shaft and when extended, the needles may extendat least partially within channel in a deployed or extend configuration.Each of the needles may extend at an angle relative to the longitudinalaxis of the shaft, e.g., anywhere from 15 degrees to 25 degrees or more,such that the needles extend angularly towards a single or multiplelocking channels which extends along the shaft interior within channel.Each of the needles may be angled proximally towards the handle tofacilitate securement of the needles through the tendon during aprocedure such that the user may readily pull on the shaft whiledeploying the needles into the channel and into or through a tendonpositioned within the channel while retracting the device to ensuresecurement to the tendon.

The shaft may be introduced through a single incision, e.g., 3 cm inlength, which may be in proximity to the rupture between a first orsuperior portion of tendon and a second or inferior portion of thetendon such that the channel is oriented towards the damaged tendon.Because the handle assembly is angled relative to the channel, the gripmay be angled away from the patient's foot and remain freely operablewithout interference.

Once the shaft has been introduced through the incision and intoproximity to the ruptured tendon, a first portion of the ruptured tendonmay be manipulated to lie at least partially or entirely within thechannel. Once suitably positioned, the actuator on handle assembly maybe gripped or otherwise manipulated to deploy the one or more needles toextend into the channel. Once the one or more needles have piercedentirely through the tendon and into their respective needle receivingchannels, each of the needles may be actuated to retract proximally backinto the shaft while leaving a length of suture which is interconnectedwith one another (or a single common length of suture) passing throughthe tendon such that each suture loop remains within each respectiveneedle receiving channel. An elongate cinching member having a hook orgrasping member at its distal end may be positioned within the lockingchannel such that the grasping member is initially positioned within adistal end of the locking channel. With the suture loops positionedwithin each needle receiving channel, the grasping member may then betensioned or pulled proximally such that each of the suture loops aresecured and tensioned proximally through the locking channel and throughthe assembly where the entire length of suture may be tensioned fortightening against the tendon.

Alternatively, a terminal end of the common length of suture may besecured to the grasping member such that when the cinching member ispulled proximally, the terminal suture end may be passed through each ofthe suture loops and pulled proximally through the assembly such thatthe terminal end may be tightened through each suture loop whereby asingle common suture length is secured to the tendon.

In yet another example of a tendon repair assembly, one or more needlesmay be rotatably positioned along the shaft such that the needles may berotated upon pivots to extend proximally towards the handle. With eachneedle having a length of suture positioned therethrough or therealong,the shaft may be pulled proximally to drive each of the angled needlesinto and through the tendon until the suture loops are passed throughthe tendon. A cinching member may then be pulled proximally relative tothe shaft such that a terminal end of the suture length attached to thegrasping member is passed through each of the suture loops.

Yet another variation of the tendon repair assembly may define areceiving channel with the one or more needles housed in an off-setneedle housing. Another example may comprise a curved needle rotatablycoupled to the shaft via a corresponding pivot supported upon pivotingmembers. When actuated, the one or more needles may rotate upon thecorresponding pivot to pass through the tendon in a curved manner.Another example may comprise a curved needle extending away from theshaft.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A to 1C respectively show bottom, side, and partialcross-sectional end views of a tendon repair assembly which may beintroduced into the body in a minimally invasive manner.

FIG. 2 shows a perspective view of an example for introducing the repairassembly through a single incision in proximity to the damaged tendon.

FIG. 3 shows a posterior view illustrating an incision through which theassembly may be introduced in proximity to the damaged tendon.

FIGS. 4A and 4B show bottom and partial cross-sectional end views,respectively, of a damaged segment of tendon having multiple lengths ofsuture passed through simultaneously or sequentially.

FIGS. 4C and 4D show bottom views of the tendon segment having multiplelengths of suture passed through by their respective needles and acinching member for tightening each of the suture lengths.

FIGS. 5A and 5B show bottom and partial cross-sectional end views,respectively, of another variation where multiple lengths of suture maybe passed through simultaneously or sequentially in a crossing pattern.

FIGS. 5C and 5D show bottom views of the tendon segment having multiplelengths of suture passed through in a crossing pattern.

FIGS. 6A and 6B show side and cross-sectional side views of one exampleof the needle assemblies for delivering and deploying suture lengthsthrough the tissue.

FIGS. 7A and 7B show perspective views of another example of the needleassembly which defines an open channel or groove for positioning of thesuture length about an opening through which the cinching suture may bepassed.

FIGS. 8A and 8B show perspective views illustrating how the needleassembly may be positioned within or along the common locking channelsuch that the cinching member and cinching suture may be passed throughthe openings within each needle assembly subsequently allowing for theneedle assemblies to be retracted while leaving the looped suturebehind.

FIGS. 9A to 9C show posterior views of another variation of a tendonrepair assembly having one or more needles which are pivotablydeployable prior to advancement into or through the tendon for passinglengths of suture therethrough.

FIG. 10 shows a posterior view of the resulting suture lengths passedthrough a portion of the tendon prior to removal or repositioning of theassembly.

FIG. 11 shows a posterior view of the sutured tendon and the resultingsecurement of the suture to the tendon when tightened.

FIG. 12 shows a posterior view of the ruptured tendon having bothcomplementary segments sutured via a repair assembly through a singleincision for approximation and securement to one another.

FIGS. 13A and 13B show perspective and end views, respectively, ofanother variation of the tendon repair assembly where the one or moreneedles may be deployed from an off-set portion of the elongate housing.

FIGS. 14A to 14C show end views of additional variations of the tendonrepair assembly utilizing one or more curved needles which may rotateabout a corresponding pivot for advancement into or through the tendon.

DETAILED DESCRIPTION OF THE INVENTION

In repairing damaged regions of tissue, an elongate assembly may beintroduced into a single incision to access the damaged tissue. Rupturedor torn tendons in particular may be difficult to repair due to thefibrous and relative toughness of these tissues. Additionally, rupturedor torn tendons may be unsupported within the body thus requiring thesecurement and approximation of the torn edges towards one another.Thus, a tendon repair assembly may generally comprise an elongate bodywhich allows for insertion of the instrument through a relatively smallincision into proximity of the damaged tendon. The assembly may comprisea channel for receiving a portion of the tendon and which may providesupport to the tissue during repair. Although described in reference tothe suturing and repair of tendons, particularly the Achilles tendon,the devices and methods described herein may be utilized on other tissueregions.

Turning now to the bottom and side views of FIGS. 1A and 1B, an exampleof a tendon repair assembly 10 is illustrated as having a handle housing12 with a handle grip 14 and an actuator 16 operable relative to thehousing 12. An elongate shaft 18 may extend from the housing 12 andterminate with a distal end 20 which may be rounded or atraumatic toprevent damage to surrounding tissues when the elongate shaft 18 isintroduced into the body of the patient. The length of the elongateshaft 18 may extend to about 5 cm although the shaft may be lengthenedor shortened as desired or necessary. Moreover, the shaft may have acircular cross-sectional shape ranging, e.g., between 2 to 2.5 cm indiameter, while in other variations the cross-sectional shape may beelliptical or another shape conducive for atraumatic insertion withinthe patient's body.

The elongate shaft 18 may define a receiving channel 22 which runs alongat least a portion of the length of the shaft 18 and allows for thedamaged or ruptured tendon to be inserted or enclosed at least partiallyor completely within the channel 22. The opening of the channel 22 maybe sized sufficiently to allow for entry of the tendon within and mayaccordingly vary depending upon the application and size of the tendon.Typically, the channel 22 may range anywhere from 45 degrees to 180degrees relative to the circumference of the shaft 18, as shown in thepartial cross-sectional end view of FIG. 1C, but the opening may be lessor greater depending on the application. Moreover, the channel 22 may bedefined along the shaft 18 at an angle relative to an orientation of thehandle 12. In one example, the grip 14 of handle 12 may be angled, a,anywhere from about 45 degrees or greater, e.g., 90 degrees, about thelongitudinal axis of the shaft 18 relative to the opening of channel 22,as shown in FIG. 1C. Having an angled orientation between the handle 12and the channel 22 may allow for the insertion of the shaft 18 into theposterior region of the patient's leg to access the Achilles tendonwithout any interference between the handle 12 and the patient's foot orleg.

One or more needles 24 which are retractably or pivotably extendablewithin channel 22 may be positioned within or along the walls of shaft18 such that when retracted, the needles 24 may be flush or hiddenwithin shaft 18 and when extended, needles 24 may extend at leastpartially within channel 22. Each of the needles 24 may extend at anangle relative to the longitudinal axis of the shaft 18, e.g., anywherefrom 15 degrees to 25 degrees or more, such that the needles 24 extendangularly towards a common locking channel 26 which extends along theshaft 18 interior within channel 22, as shown in FIG. 1C. The needles 24may be pre-formed to have a curve or arcuate shape or they may becomprised of a shape memory alloy such as a nickel-titanium alloy (e.g.,Nitinol) whereby the needles may reconfigure from a straightenedconfiguration to a curved configuration when deployed. Alternatively,the needles may be fabricated from a spring stainless steel which maycurve when deployed as well. FIG. 1A illustrates at least three needles24 on either side of channel 22 (for a total of six needles) andextending into channel 22 angled proximally towards handle 12 such thateach needle 24 is offset relative to an adjacent needle 24. Each of theneedles 24 may be angled proximally towards the handle 12 to facilitatesecurement of the needles 24 through the tendon during a procedure suchthat the user may readily pull on the shaft 18 while deploying theneedles 24 into channel 22 and into or through a tendon positionedwithin the channel 22 while retracting the device to ensure securementto the tendon.

In other variations, each of the needles or alternating needles may beangled to extend into channel 22 at various angles relative to oneanother. Additionally, while six needles 24 are shown in this example,some variations may utilize fewer needles while other variations mayutilize a greater number of needles. Moreover, with multiple needles 24being deployed, each of the needles 24 may be deployed simultaneouslywhen actuated or they may be deployed sequentially in a predeterminedmanner by varying the actuation mechanism for needle deployment.

In an example of use, FIG. 2 illustrates a perspective view of anassembly 10 introduced into the posterior region of a patient's leg 32superior to the foot 30 and in proximity to a ruptured or damaged tendon34. As shown in both FIGS. 2 and 3 which illustrates a posterior view ofa ruptured tendon 34, shaft 18 may be introduced through a singleincision 36, e.g., 3 cm in length, which may be in proximity to therupture 42 between a first or superior portion 38 of tendon 34 and asecond or inferior portion 40 of tendon 34 such that the channel 22 isoriented towards the damaged tendon 34. Because the handle assembly 12is angled relative to the channel 22, grip 14 may be angled away fromthe patient's foot 30 and remain freely operable without interference.

Once the shaft 18 has been introduced through the incision 36 and intoproximity to the ruptured tendon 34, a first portion 38 of the rupturedtendon may be manipulated to lie at least partially or entirely withinchannel 22. Once suitably positioned, actuator 16 on handle assembly 12may be gripped or otherwise manipulated to deploy the one or moreneedles 24 to extend into channel 22. As shown in the detail bottom viewof FIG. 4A and the partial cross-sectional end view of FIG. 4B, the oneor more needles 24 may extend through corresponding openings 50 definedalong the interior of channel 22 from shaft 18 such that the needles 24pierce into and through the tendon 38, as indicated by the direction ofdeployment 54, until the piercing tips of each needle 24 extend into acorresponding needle receiving channel 52 defined along the lockingchannel 26. The tendon 38 typically ranges in width from about 2 cm sothe travel distance for a needle 24 passing through the tendon 38, asindicated in FIG. 4B, may range from about 1 to 1.5 cm for securement.

Once the one or more needles 24 have pierced entirely through the tendon38 and into their respective needle receiving channels 52, each of theneedles 24 may be actuated to retract proximally back into shaft 18, asindicated by the direction of retraction 56 shown in FIG. 4C. Each ofthe needles 24 may carry a length of suture which is interconnected withone another (or a single common length of suture) such that once theneedles 24 are retracted, they may each leave a suture length 58 and adefined suture loop 60 passing through the tendon 38 such that eachsuture loop 60 remains within each respective needle receiving channel52. An elongate cinching member 62 having a hook or grasping member 64at its distal end may be positioned within the locking channel 26 suchthat the grasping member 64 is initially positioned within a distal endof the locking channel 26. With the suture loops 60 positioned withineach needle receiving channel 52, the grasping member 64 may then betensioned or pulled proximally, as indicated by the direction ofcinching 66 shown in FIG. 4D, such that each of the suture loops 60 aresecured and tensioned proximally through the locking channel 26 andthrough the assembly where the entire length of suture may be tensionedfor tightening against the tendon 38.

Alternatively, a terminal end of the common length of suture may besecured to the grasping member 64 such that when the cinching member 62is pulled proximally, the terminal suture end may be passed through eachof the suture loops 60 and pulled proximally through the assembly suchthat the terminal end may be tightened through each suture loop 60whereby a single common suture length is secured to the tendon 38.

FIGS. 5A and 5B show bottom and cross-sectional end views of anothervariation of the tendon repair assembly. In this example, rather thanutilizing a single locking channel, a first locking channel 70 and asecond locking channel 72 may be utilized where each of the channels 70,72 are parallel and spaced apart from one another. In this manner,apposed needles 24 may extend from shaft 18 in a crossing manner whendeployed, as shown in FIG. 5A. As described above, once the needles 24have been passed into and through the tendon 38, as shown in FIG. 5B,and received into each respective needle receiving channel 52, theneedles 24 may be retracted proximally while leaving each respectivesuture length 58 and suture loop 60 positioned within each channel 52,as shown in FIG. 5C. A first cinching member 74 having a first hook orgrasping member 76 may be pulled proximally through the first lockingchannel 70, as indicated by the first member direction of cinching 82and a second cinching member 78 having a second hook or grasping member80 may also be pulled proximally through the second locking channel 72,as indicated by the second member direction of cinching 84, to cincheach of the suture loop 60 and to tighten the suture lengths against thetendon in a crossing manner, as shown in FIG. 5D.

Turning now to the needles 24, each of the needles may have a piercingtip for passing through the tissue. A needle opening 90 may be definedat the piercing tip in communication with a suture lumen 94 definedthrough each needle. A length of the suture 58 may pass through thesuture lumen 94 while resting against a suture abutment 92 such thatduring needle deployment, the suture 58 may readily pass through thetendon along with the needle travel. As the needle is retractedproximally, the suture 58 may have slack introduced into the length suchthat proximal movement of the needle 24 may urge the suture 58 throughthe suture lumen 94 and distally out through the needle opening 90 thusleaving a defined suture loop 60 extending from the suture length 58, asshown in the side and cross-sectional side views of FIGS. 6A and 6B.Alternatively, a pre-defined loop of suture may be formed at the distalend of suture length 58 such once deployed from the needle 24, thesuture loop 60 may retain its looped shape once extended from the needle24. Other variations for forming a suture loop may also be utilized withthe tendon repair assembly described herein.

FIGS. 7A and 7B show perspective views of another example of a needleassembly 89 which is configured to allow for the passage and cinching ofa cinching member and suture length directly through the needle assemblyand defined suture loops. As shown, the suture length 58 may be a singlesuture which is slidably positioned within a channel 91 which is definedalong either length of the needle body 97. In this example, channel 91may be open along the entire length of the needle such that the suturelength 58 remains open and is not enclosed or trapped within the needleitself. The distal end of the needle body 97 may comprise a first yokemember 99 and a second yoke member 101 which define an open passage 93therebetween. A portion 95 of the suture length 58 may remain exposedbetween the distal tips of the first and second yoke members 99, 101such that a cinching member or cinching suture passed through the openpassage 93 may be released from between the yoke members 99, 101 andallow the suture length 58 to slide along the channels 91 such that theextended suture length 58 form a suture loop 60, as shown in FIG. 7B.

This particular design may allow for the needle assembly 89 to fullyretract after each suture loop 60 has been threaded thus leaving thesuture length 58 behind. As previously described, the open passage 93may allow the grasping member or cinching suture to pull (or push)through each suture loop 60. Once the terminal end of the cinchingsuture is pulled external to the body and grasped by the user, thegrasping member can be released back through the guide channel or pulledout entirely thus allowing for the needle assemblies 89 to be retractedleaving behind only the interlocking suture loops for cinching.

As further illustrated in FIGS. 8A and 8B, perspective views of theneedle bodies 97 are shown deployed through the tendon and into thecommon locking channel 26, which may remain opened along its length,With the open passage 93 of each needle assembly linearly aligned withinthe locking channel 26, a grasping member 62 may be pushed or pulledthrough the length of the locking channel 26, as indicated by thedirection 105. Because of the linear arrangement of the open passage 93of each needle within the locking channel 26, the grasping member 62 maypass directly through each open passage 93, as shown in FIG. 8A. Thegrasping member 62 may be pulled or pushed through the device until theterminal end of the cinching suture 103 is urged through each openpassage 93 by the grasping member 62 such that each suture loop 60 isaccordingly retained by the cinching suture 103, as shown in FIG. 8B.Once the cinching suture 103 has been passed through each of the sutureloops 60, the grasping member 62 may be removed from the device orretracted proximally through the locking channel 26 leaving only thecinching suture 103 locked through each suture loop 60. The needle body97 may then be retracted proximally, as previously described, such thatthe cinching suture 103 passes through the open passage 93 and outbetween each of the yoke members 99, 101 while retaining each of thesuture loops 60. The terminal end of the cinching suture 103, which maybe drawn external to the patient's body, may then be tensioned andtightened by the user to secure each of the suture lengths 58 andcinching suture 103 to the tendon, as indicated by the direction 105 andas described herein.

In yet another example of a tendon repair assembly, FIGS. 9A to 9Cillustrate a variation where one or more needles may be rotatablypositioned along the shaft 18. As above, the shaft 18 may be introducedinto proximity to the tendon to be repaired through a single incision inproximity to the rupture 42. In the example shown, shaft 18 may beadvanced adjacent to the first portion of tendon 38 such that theneedles 24 are positioned in proximity to the tendon surface, as shownin FIG. 9A. Each of the needles 24 may be rotated upon correspondingpivots 100 such that the needles 24 are angled to extend proximallytowards the handle. With each needle 24 having a length of suturepositioned therethrough or therealong, the shaft 18 may be pulledproximally to drive each of the angled needles 24 into and through thetendon 38 until the suture loops 60 are passed through the tendon 38, asshown in FIG. 9B. A cinching member 62 may then be pulled proximallyrelative to the shaft 18 such that a terminal end of the suture lengthattached to the grasping member 64 is passed through each of the sutureloops 60, as shown in FIG. 9C.

With the suture lengths 58 secured, shaft 18 may be advanced distally,as shown, until each of the needles 24 are cleared from the tendon 38thus allowing the needles 24 to be retracted or angled back against theinterior channel of shaft 18, as shown in FIG. 10. The resultingprocedure may thus result in the tendon 38 having a single suture lengthsecured to the tendon 38 with a first terminal suture end 110 and asecond terminal suture end 112 extending from the tendon 38. FIG. 11shows a superior view of the resulting tendon 38 having a single suturelength secured thereto. One or both terminal suture ends 110, 112 may betensioned, as shown, to draw the suture tightly against the tendon 38.The tendon repair assembly may then be withdrawn from the incision andre-inserted into (or simply re-oriented) the incision in an oppositedirection to then secure a second length of suture 120 to the inferiorportion of tendon 40 in the same or similar manner. The resultingprocedure may result in the second length of suture 120 being secured tothe second tendon 40 with a first terminal suture end 122 of the secondsuture 120 and a second terminal suture end 124 of the second suture120, as shown in FIG. 12. Each of the terminal suture ends 110, 112extending from the superior portion of tendon 38 and the terminal sutureends 122, 124 extending from the inferior portion of tendon 40 may thenbe drawn through the incision to coapt the ruptured portions of tendonagainst one another and tightened to secure the tendon for healing. Thesingle incision may then be closed with minimal trauma to the patient.

FIGS. 13A and 13B show perspective and end views of yet anothervariation of the tendon repair assembly. In this example, the elongateshaft 130 may define a receiving channel 134, as previously described,but the one or more needles 24 may be housed in an off-set needlehousing 132. The needle housing 132 may project from shaft 130 and theone or more needles 24 may be curved such that when actuated, each ofthe needles may pass through the tendon in a curved or arcuatetrajectory for passing the suture 136 therethrough.

FIG. 14A shows yet another example where the curved needle 24 may berotatably coupled to the shaft 130 via a corresponding pivot 140supported upon pivoting members 142. When actuated, the one or moreneedles 24 may rotate upon the corresponding pivot 140 to pass throughtendon 38 in a curved manner. FIG. 14B shows another example there thepivot 140 and curved needle 24 may extend away from the shaft 130 whileFIG. 14C shows yet another example where the one or more needles 24 maybe supported upon the shaft 130 and pivotably mounted via acorresponding pivot 140.

The applications of the disclosed invention discussed above are notlimited to certain treatments or regions of the body, but may includeany number of other treatments and areas of the body. Modification ofthe above-described methods and devices for carrying out the invention,and variations of aspects of the invention that are obvious to those ofskill in the arts are intended to be within the scope of thisdisclosure. Moreover, various combinations of aspects between examplesare also contemplated and are considered to be within the scope of thisdisclosure as well.

What is claimed is:
 1. A tissue repair apparatus, comprising: a housingdefining a cavity for receiving tissue; a locking channel extending in alongitudinal direction through the housing; and a plurality of needlesat least partially disposed within the housing, the plurality of needlesrotatable from a pre-deployment position in which a distal tip of eachof the plurality of needles is spaced from the locking channel to adeployed position in which at least the distal tip of each of theplurality of needles is positioned within the locking channel, whereinthe distal tip of the each of the plurality of needles rotates at leastpartially about an axis extending parallel to the longitudinaldirection.
 2. The apparatus of claim 1, further including a suturecarried by the plurality of needles such that the suture defines asuture loop extending from each one of the plurality of needles.
 3. Theapparatus of claim 2, wherein the suture is a single common length ofsuture.
 4. The apparatus of claim 2, further including a cinching memberand a cinching suture slidably aligned along the locking channel.
 5. Theapparatus of claim 4, wherein when the plurality of needles is in thedeployed position, the cinching member is aligned with the plurality ofsuture loops for slidably passing the cinching suture through each oneof the plurality of suture loops.
 6. The apparatus of claim 1, whereinwhen the plurality of needles is in the pre-deployment position, theplurality of needles is positioned within or along a wall of thehousing.
 7. The apparatus of claim 1, wherein each of the plurality ofneedles is curved at least when in the deployed position.
 8. Theapparatus of claim 1, wherein when the plurality of needles is in thepre-deployment position, each one of the plurality of needles ispositioned on a same side of the locking channel.
 9. The apparatus ofclaim 1, wherein the cavity of the housing is sized for receiving anAchilles tendon.
 10. The apparatus of claim 1, further comprising ahandle assembly attached to a proximal end of the housing, the handleassembly extending in a direction traverse to the locking channel. 11.The apparatus of claim 10, wherein actuating the handle assembly causesthe plurality of needles to simultaneously deploy.
 12. The apparatus ofclaim 1, wherein each one of the plurality of needles comprises a suturechannel.
 13. The apparatus of claim 1, wherein each one of the pluralityof needles is mounted on a shaft disposed within the cavity of thehousing.
 14. A tissue repair apparatus, comprising: a housing defining acavity for receiving tissue; a locking channel extending in alongitudinal direction through the housing; a plurality of needles atleast partially disposed within the housing, the plurality of needlesrotatable from a pre-deployment position in which a distal tip of eachof the plurality of needles is spaced from the locking channel to adeployed position in which at least the distal tip of each of theplurality of needles is positioned within the locking channel; and asuture carried by the plurality of needles such that the suture definesa suture loop extending from each one of the plurality of needles,wherein the distal tip of each of the plurality of needles rotates atleast partially about an axis extending parallel to the longitudinaldirection, wherein when the plurality of needles is in the deployedposition, each one of the suture loops is longitudinally aligned withone another along the locking channel.
 15. The apparatus of claim 14,further including a cinching member having a cinching suture slidablyaligned along the locking channel.
 16. The apparatus of claim 14,wherein the plurality of needles includes three needles.
 17. Theapparatus of claim 14, wherein when the plurality of needles is in thepre-deployment position, the plurality of needles is on a same side ofthe locking channel.
 18. The apparatus of claim 14, wherein theplurality of needles is made of a shape memory alloy and configured totransition from a substantially straight configuration when in thepre-deployment position to a curved configuration when deployed.
 19. Theapparatus of claim 14, wherein the housing has a circular or ellipticalcross-sectional shape in a plane perpendicular to the axis.
 20. Theapparatus of claim 19, wherein the housing has a maximum diameter of 2.5cm or less.